Provider Demographics
NPI:1609634930
Name:WIREGRASS DRUGS INC
Entity Type:Organization
Organization Name:WIREGRASS DRUGS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:C
Authorized Official - Last Name:ALLIGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-435-4571
Mailing Address - Street 1:PO BOX 72188
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31708-2188
Mailing Address - Country:US
Mailing Address - Phone:229-435-4571
Mailing Address - Fax:229-878-4926
Practice Address - Street 1:430 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ASHFORD
Practice Address - State:AL
Practice Address - Zip Code:36312
Practice Address - Country:US
Practice Address - Phone:334-899-3100
Practice Address - Fax:334-899-3186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy